• General Scan Protocol ( added this and attach the general scan protocol video)
• Preparation for Scan – Dr. Cooper Williams
• Superficial Digital Flexor Tendon – Dr. Cooper Williams
• Suspensory Ligament – Dr. Cooper Williams
• Accessory Carpal Ligament of the Deep Digital Flexor Tendon – Dr. Cooper Williams
• Lateral & Medial Borders of the Superficial Digital Flexor Tendon – Dr. Cooper Williams

The ideal video should be limited to a size of 300-400 frames. Set the frame rate to 30 frames per second and obtain a transverse B-Mode (Brightness Mode) Video Scan of up to 12 to 14 seconds of the soft tissue item (tendon, ligament, muscle, etc.).

The entire video length may not be greater than 14 seconds total, however it may include time at the beginning and end of the scan where the sonographer is adjusting the angle of insonation, stabilizing the probe, or scanning regions beyond the targeted area. This extraneous video time must be cropped out using the app’s editing feature.

Turn the video recorder on and slowly, steadily sweep the soft tissue item from proximal to distal at a rate no greater than about one inch (2.5 cm) per second, keeping the probe perpendicular to item and axially centered.

You may want to scan the entire item or only scan a region of interest along with short regions of approximately equivalent lengths proximal and distal to it. In this case you may want to decrease the sweep rate to increase the number of frames per unit length.

With scanning complete the video data can then be uploaded and processed.

Each soft tissue item should be scanned independently after a generalized scan is performed. For example, if the superficial digital flexor tendon (SDFT) were to be imaged on a patient one would first sweep the palmar metacarpal soft tissue before adjusting the depth of field to focus on just the SDFT.

Use a Linear Array Transducer and keep the angle of insonation at or as close as possible to 90 degrees. Keep the probe as perpendicular as possible to the soft tissue item while minimizing axial rotation. Small deviations from 90 degrees will cause rapid loss of detail and quickly begin to generate an acoustic as opposed to brightness mode image.

The field of view should be adjusted before beginning video capture. This is done by altering the depth of field (wave penetration) to make sure the structure of interest occupies the maximum amount of the field of view. The result will be a higher resolution image than if the structures is viewed in only one part of the image and other anatomic structures are present.

To obtain the optimal frequency for sonographic evaluation of tendon and ligament tissue it is imperative that the machine operates in Resolution Mode (RES). For deeper structures or if the penetration is insufficient General Mode (GEN) can be used but will not provide as high a quality of image.

Note: the optimal frequency to scan the Superficial Digital Flexor Tendon (SDFT) is between 10-12 MHz. Optimal frequency for tendons is 10-12 KHz.

Gain is the strength (the brightness) of the returning echo. Adjusting the Gain adjusts the brightness of the image. Make sure the brightness of the image is uniform from top to bottom of the field of view. This is best accomplished by adjusting the Gain with the Auto Gain Button or ensuring that the Far Field and Near Field Gain Controls are set at equal intensities.|

Adjust the brightness to its optimal value. This parameter is a matter of experience in some instances as the clinician will be familiar with the optimal gain for a selected anatomic structure. One approach is to identify an area of hypoechoic tissue (liquid) and adjust the Gain until the liquid region appears black.

If you are going to use Connect, you need to do a one time setup of your ultrasound machine. To do so please enter the following information in your scanner or device. to connect to our DICOM receiver. The AE Title number is generated automatically the first time you connect. The number displayed below is an example.

• Location AE Title: faa82ef06192681f
• Receiver AE Title: MIT-DCM-001
• Receiver Server Address: 3.132.192.178
• Receiver Port #: 11104

When uploading from a local device such as a laptop, desktop, tablet, iPad you can use WiFito upload or HotSpot your cell phone and Tether it to your local device.

If the video is in DICOM Format the Patient information that is available is extracted from the Metadata of the video and entered in the Patient Information form. If the information in the form is incomplete the missing Metadata was not entered by the scanner at the start of the scan. If such is the case, please enter the missing information and proceed.

The application uploads Ultrasound B-Mode Videos and process them with the company’s algorithm. The application has a Navigation Bar at the top of screen with six navigators running left to right. The navigators are:

• Dashboard
• Upload
• Trimmer
• Crop
• Payment
• Report

Each navigator has a toolbar that is displayed on the left-hand side of the screen when you click on it. The tools are displayed as Icons. If you click on the three parallel blue lines Icon in the top left hand corner it converts to an X and displays descriptive text for each icon in the toolbar. If you click on the X it collapses the descriptor text and reverts to the three parallel blue lines Icon.

Enter URL https://equine.morphometrix.com

Enter Username & Password

Click on the Login Button

To initiate processing of a New Scan, Click on Dashboard Navigator in the Navigation Bar and then click on New Scan in the Dashboard Tool Bar on the left-hand side of the screen and choose one of four options.

• Reset Scan: Click on this if you want to restart the scan process
• Upload: Upload scan video from local device such as laptop, desktop, tablet, iPad
• Drop: Drag and drop scan video from local device such as a laptop, desktop, tablet. iPad
• Connect: Connect ultrasound machine to DICOM Converter and upload directly from machine.

Enter the patient, user client and admin data – you will see a display “waiting for patient information” and be prompted by the creating new patient display to enter the patient, user client and admin data in that order. Please enter it in order from top to bottom.

Click Create.

The application uploads the video and creates an Mp4 format Video for the Video Trimmer. You will see a progress bar labeled Uploading and rotating Morphometrix Logo above it during the upload. However, a progress bar is not displayed for upload directly from an Ultrasound Machine.

You will see a rotating Morphometrix Logo with text “Creating Video” beneath it during creation of the Mp4 format video for Upload or Drag & Drop from a local device.

Please note that you can upload multiple videos and then process them sequentially or in any order you chose if you are uploading directly from an Ultrasound Machine via Connect. However, if you are uploading from a local device such as a Laptop, Desktop, iPad or Tablet you must complete the upload, the video trimming, set the ruler, complete the cropping and start processing the video before starting another upload.

You cannot start processing another video until the video being processed is complete.

When you click Proceed, the application uploads the video and creates an mp4 format video for the Video Trimmer. The time required is highly variable. It depends on multiple factors including the size and resolution of the video, and the speed WiFi or Cell Network used to do the upload.

There is a high variability in the quality, stability and speed of WiFi Networks. We have found that many cell networks upload much faster than WiFi networks and are more stable. We have tested cell networks which often upload significantly faster than corresponding local WiFi networks. However, this may not always be the case. We recommend you test both and compare speed. Use the cell network if there are stability issues with your WiFi.

There may be a Workflow hold point for the veterinary technician or practitioner. You can perform other clinical activities while the Video uploads and the application creates the Mp4 format video for trimming.

You can trim the Video from the left or the right or both with the slide bar of the Video Trimmer and click Proceed. If the video is OK as is, you do not have to trim it. However, check the start and end of the video to ensure you have the correct starting point for the anatomical structure and have not overshot its end point. You may also want to trim the video to only include a region of interest and optionally regions proximal and distal to it.

The application creates the Trimmed Video and Extracts the 11 frames for cropping. You will see rotating progress bar & Morphometrix Logo with text “Trimming Video” beneath it followed a Rotating Morphometrix Logo with text “Extracting Frames for Cropping” beneath it. This takes you into the toolbar of the Crop Navigator.

The ruler sets a 1cm distance for calculation of the cross-sectional area of the anatomical structure. The largest increments in the depth scale on the right-hand side of the view usually correspond to 1cm.You can return to the Ruler and re-adjust it. For instance, if you see 3.3 at the bottom of the scale it means the total depth is 3.3 cm and the scale should have three equidistant horizontal markers that each correspond to 1 cm depth.

Left click next to a marker on the depth scale and drag to next 1 cm increment marker and left click.

You can crop the eleven frames sequentially or randomly and return to any frame to readjust the cropping points at any time during the cropping process. You can crop a frame in either a clockwise or anti-clockwise direction.

The cropping points are the yellow and blue points between the yellow points are cropping points that can be added by placing the cursor over them and left clicking. If you click on a blue point it becomes a yellow cropping point and a new blue point appears on either side of it. Your can remove a cropping point by placing the cursor over it and double clicking.

To start the cropping click at some point on the perimeter of the anatomical structure. A pink crop point appears as the first crop point. Go around the perimeter adding points until you return to the pink starting point. Hover the cursor over it and left click to complete the cropping.

The location of each cropping point is adjustable by placing the cursor over it, left clicking and dragging.it to a preferred location. Adjust the cropping point of each frame to best fit the anatomical structure as you go.

Each frame has three options at the end of the cropping 

• Previous – returns you to the previous frame
• Clear – clears the cropping point and allows you to re-crop the entire frame
• Next – takes you to the next frame for cropping
  

Recall Cropping Points – You do not need to enter new cropping points for each frame after you have cropped the first frame if you crop the frames sequentially. If you click on the “Recall Cropping Points” icon on the toolbar on the left-hand side it recalls the cropping points from the previously cropped slide and inserts them in the current frame, and you can then adjust the points as necessary and proceed to the next slide. This avoids the need to insert new cropping points on each frame, although this option does exist.

Process – Click Process at the end of cropping of the eleventh frame. This takes you into Payment Navigator to make the payment. This assumes all eleven frames are cropped. If the application does not take you to the Payments click each frame to see if it is cropped and crop the frame(s) which have not been cropped. Once all the frames are cropped return to the eleventh frame and click Process again.

Make the payment by entering the payment Information and click confirm

The Report Navigator in the Navigation bar REPORT appears as a display in the Window while the video is being processed. You will see a progress bar with a rotating Morphometrix Logo above it during processing.

Do not begin processing another scan until “Report” appears in the as a display in the Window.

You can upload and process another video while the current video is processing by clicking Dashboard in the Navigation Bar at the top of the page and then clicking on New Scan in the toolbar on the left-hand side of the page.

This may be a Workflow hold point for the where the veterinary technician or practitioner can perform other clinical activities while the video is processing. The application will display results when the processing is completed. You can check periodically to see if the processing is complete.

Your can also continuing to work in the application by accessing Processed Scans through My Scans Icon of the Dashboard Navigator Icon in the toolbar on the left-hand side. You will see the My Scans Icon blinking while the video is processing. Just click on it to enter the My Scans display.

While you are in My Scans you can return to the video being processed by left clicking on view in its Scan Results Field. This takes you back to the video being processed.

The video display in the Window at the end of the processing of the video and the Closed Contours Video is displayed.

Note: Each step in the reprocessing is optional unless you re-trim the video in which case you must redo all steps thereafter, including re-cropping all eleven frames

• • Step 1: Click on the Dashboard in the Navigation Bar and then on My Scans in the Dashboard Navigator Toolbar. Once in the My Scans display click Details View of a specific scan to displays the Details View.
    
  • Step 2: Click on the Reprocess Button beneath and slightly to the right of the Scan I.D in the Details View Display.
    
  • Step 3: This takes you to Upload on the Navigation Bar which displays the PATIENT DATA and Icon saying UPLOADED VIDEO. Make any changes you wish and click Save.
  • Step 4: Click on Trimmer on the Navigation Bar and re-trim (optional) the video and click on Proceed
    
  • Step 5:This takes you to the Ruler. Reset the Ruler (optional) and click Done
    
  • Step 6: Go to the Navigation Bar and Click Crop. which takes you to the cropping menu where you can re-crop or adjust the current cropping and click Reprocess. You can also go to the Ruler Tool. reset the Ruler the click Done.
  • Step 7: Go to Payment on the Navigation Bar and click Continue. The video will then reprocess as displayed in the Report Navigation
    

Video of 2D segmented cropped frames overlain on unprocessed cropped frames

A video of 2D segmented cropped frames

A video of 2D unprocessed cropped frames

The application fetches the 3D Object file and Builds a 3D Object and creates a 3D Image. You will see a progress bar with a rotating Morphometrix Logo above it as the application fetches the 3D Object but only a rotating Morphometrix Logo as the application builds the 3D Object.

This takes you into the 3D Viewer where a 3D image appears in the window entitled 3D RESULTS.

You can now view and examine the image in 3D. See the section “OPERATING THE 3D VIEWER” for instructions on its operation.|

Fetching 3D Object may be is a workflow hold point for the vet tech or practitioner using the application, this can take some time, depending on the size and resolution of the processed scan.

Displays the interactive graphs of fiber bundle counts by frame # and the cross-sectional area by frame #

A slide show of 28 segmented 2D frames from start to finish

A slide show of 28 unsegmented 2D frames from start to finish

Three direct output from the Algorithm

A cross-sectional example of a segmented image overlain on the unprocessed image

Frontal and longitudinal Views of a Slice.

Fiber bundle count of the final frame and a Histogram of fiber bundle areas for the final frame

You can view the image in transverse (X AXIS VIEW), longitudinal (Y AXIS VIEW) and sagittal (Z AXIS VIEW) and you can elongate the image by up to an order of magnitude (a factor or 10) in each view. There are four icons on the left-hand side of the view from top to bottom – X AXIS VIEW, Y AXIS VIEW, Z AXIS VIEW, ELONGATION – which take you into the different views and elongation.

You can select a slice in each view with slice selector scroll bar in 3D view and then click View Slice to view the slice and take a snapshot. To take a snapshot click on the AXIS Label (e.g. Z-AXIS) next to the Camera Icon and click on print in the dropdown menu to print an image of the slice directly to your local computer device. You can toggle between 3D View and 2D Slice View by clicking on 3D View and View Slice

You can scroll through slices in each view and take snapshots of each slice. Currently, you must print the snapshots directly to your computer. The APP does not save them.

To elongate a dimension of the image, click on the Elongation Icon in either 3D View or 2D View Slice in any of the views; X (transverse), Y(longitudinal) or Z(sagittal).

For example, click on the Z AXIS VIEW in 3D and then click on the Elongation Icon.

Click on the scroll bar at the bottom of the image at the far-right end of it. A second button will appear at the far right-hand side of the scroll bar and the image is elongated by the maximum amount – an order of magnitude. Once elongated to the maximum you can click on the scroll bar to the left of the right-hand button to reduce the elongation by 1/3.

If you then click on the scroll bar again to the left of the right-hand button it will reduce the elongation by 2/3. If you then click on the scroll bar to the left of the right-hand button it will return the image to its original size.

Click on the ELONGATION ICON again to leave the elongation tool.

You can click on the ELONGATION ICON at any point in the elongation process to the return to slice selection in either the 3D View or the 2D View Slice.

My Scans is a complete record of each scan with retrieval capabilities. You can access My Scans by clicking on the Dashboard Navigator and then on My Scans in the toolbar on the left-hand side of the screen. My Scans includes six fields.

• User Email
• Patient ID
• Horse name
• Scan date
• Details view – click on view for the scan record data
• Scan results – click on view for the scan results. This loads the results and allows for viewing and assessment

You can toggle from Details View in to Scan Results by clicking on “View” when the Details View is displayed and you can toggle back to Details View by clicking the back button in your Browser.

The downloaded results are more comprehensive than the results accessible on-line through the Browser. Click on the Download Icon to download the results to your local device in a zip file and extract the results from the Zip file. All results except for the fiber bundle chart, the cross-sectional area chart, the segmented images montage and cropping montage are downloaded; they cannot be downloaded because they are interactive.

However, the PATIENT DATA which includes the ‘ACCOUNT INFORMATION’, ‘the ‘PATIENT INFORMATION’ and the ‘SCAN DETAILS’ is not downloaded with the results. You can access this information by clicking on View in the Details field of MY Scans Tool for the Scan in question. The application will display this information and you can Print to Pdf if your Browser has this capability or, in the alternative use the Print Screen function of your local device.

Original Cropped Images – File of all cropped unsegmented 2D images

Segmented Images – File of all segmented 2D images

Excel Workbook Stats Full – Frame-by-frame fiber bundle counts and cross-sectional areas

Excel Workbook Calcs Full – Average fiber bundle counts and standard deviation of the full range of frames

Excel Workbook Calcs Quad1 – Average fiber bundle counts and standard deviation of the first quartile of the full range of frames

Excel Workbook Calcs Quad2 – Average fiber bundle counts and standard deviation of the second quartile of the full range of frames

Excel Workbook Calcs Quad3 – Average fiber bundle counts and standard deviation of the third quartile of the full range of frames

Excel Workbook Calcs Quad4 – Average fiber bundle counts and standard deviation of the fourth quartile of the full range of frames

Closed Contours Video – video of 2D segmented cropped frames overlain on unprocessed cropped frames

Segmented Video – a video of 2D segmented cropped frames

Cropped Frames Video – a video of 2D unprocessed cropped frames

Image Tendon – 3D Object. The 3D Image can be viewed by downloading 3D Viewing Software on your computer. One example is 3D Blender. It is free open source software you can get through the following URL https://www.blender.org/

Frontal Longitudinal – Frontal and Longitudinal slices

Fiber Bundles – Fiber bundle count of final frame and a Histogram of fiber bundle areas for the final frame.

Transverse – Cross-sectional cut of a cropped segmented frame overlain on a cropped. unsegmented frame.

Go to URL https://equine.morphometrix.com/ and click on Sign Up in the Pop Up Box and complete the SignUp form.

Payment is a pay-per-use click fee against a credit or debit card .Entering payment information is a one-time function. Click on the Account Settings tool in the left hand column of the Dashboard Navigator in the Navigation Bar along the top of each page of the APPLICATION and enter your credit card information in the Payment Information Section. .To pay for a scan click Process after the cropping step of processing a scan.The Application will take you to Payment in the Navigator to make your payment. Click Proceed after you have made your payment

Entering your Profile and User Information is a one-time only requirement. You enter this information by clicking on the Account Settings tool in the left hand column of the Dashboard Navigator in the Navigation Bar along the top of each page of the APPLICATION and entering your information.

You can access your Scan History by clicking on My Scans in the toolbar of the Dashboard Navigator in the Navigation Bar. My Scans contains six fields profiling your Scan History and a Search Bar where you can search your Scan History you can search by USER EMAIL, PATIENT ID, HORSE NAME, SCAN DATE, DETAILS, SCAN RESULTS.

Receipts – Receipts are generated and emailed to you for each scan and a monthly report is available for export. You can access the Receipt for each scan by Clicking on My Scans in the Dashboard Navigator and then clicking on View in the Details Field of the scan. This will bring up the ACCOUNT INFORMATION for the scan and you can click on button beneath RECEIPT. You can export a report of your Monthly Receipts by clicking on the Export button in the RECEIPTS section at the bottom of the Account Settings Page.

Deactivate Account – Enter the Application and click on the Account Settings tool on the left hand side of the page in the Dashboard Navigator. This takes you to the Account Settings Menu. Scroll down to ACCOUNT and click on the Close button.

Ultrasound B-scan image simulation, segmentation, and analysis of the equine tendon” Medical Physics March 2010 DOI: 10.1118/1.3292633

Tissue Characterization of Equine Tendons with Clinical B-Scan Images Using a Shock Filter Thinning Algorithm.” IEEE Transaction on Medical Imaging 30:597-605·March 2011

The Algorithm was validated histologically. Histology maps were generated from macro-photographic images of transverse slices of equine superficial digital flexor tendons (“SDFTs”). Acoustic impedance maps were then generated from the histology maps which were then used to generate virtual ultrasound images via ultrasound simulation. The virtual ultrasound images were processed through the algorithm to generate segmented images, and the segmented were then compared to the histology maps. Clinical ultrasound scans were then performed in vivo and processed through the algorithm to assess tissue characterization capabilities.

PDF Resource: Tissue Characterization of Equine Tendons With CLI

PDF Resource: Ultrasound B-scan Image Simulation, Segmentation, and Analysis of the Equine Tendon